Robert J. Snyder, MD
An oblique fracture is one that breaks diagonally across the width of the bone and along the longitudinal axis of the bone. Because of the shape of the bone fracture, the edges of the bone are typically quite sharp and knife-like and can cause lacerations to the skin over the fracture, causing it to become a compound or open oblique fracture. A compound oblique fracture will require surgical reduction (an operation to fix or stabilize the broken bone) and is much more prone to post-surgical complications, such as infection or non-union.
The causes of this type of fracture are usually external violence, accident or trauma or it even can be caused by muscular effort on the part of the individual. It can be caused by landing on your bone at an angle or can be caused by having force suddenly applied to a bone at an angle, as might happen in a motor vehicle accident.
Symptoms of a fracture are swelling, bruising, severe pain, deformity, inability to move the affected limb or body part, and in the case of an open/compound fracture – a bone/bone fragments protruding through the skin and minor or major bleeding from the wound, depending on vascular involvement. A suspected fracture is a reason to seek urgent medical care, and a compound fracture is a reason to seek immediate emergency care.
Diagnosing an oblique fracture is usually done by x-ray, although a CT scan may also be used. Radiographic images may also show that the bone is displaced (meaning it has moved away from its broken end) and that may be another cause for surgical intervention to repair. Depending on its severity, whether it is displaced or compound, will determine the course of treatment.
A non-displaced, non-compound oblique fracture may be treated simply by reduction (setting the bone in the correct alignment). This is typically done in the ER after a shot of local numbing medication and pain medication have been administered to the patient. After the bone has been put back into proper alignment, a removeable air cast/splint will be put on. Plaster casts are almost never used anymore, except by some orthopaedists for foot injuries. The patient will be asked to intermittently ice and elevate the broken bone for the next 24-48 hours to help with pain and swelling. The bone must be immobilized for the next 6-12 weeks for the bone to form a callus and completely heal.
For fractures that are either displaced, compound or both, surgery will be required to reduce the fracture and realign the bones. Compound fractures require that the wound be thoroughly cleaned of all external debris that may have been introduced into the body, which could be grease, glass, grass, dirt, etc. Internal fixation hardware (pins, rods, plates, screws, wires) will typically be used to provide stabilization to the bones as they fuse. Recovery is complicated by the surgical incision/pre-operative wound and the risk of infection is greater, especially if there was a compound fracture.
If there is only one broken bone and the patient has no other injuries, this surgery is performed as an outpatient procedure. If the patient has been in an accident, and there are multiple traumatic injuries, the patient may be kept in the hospital and the surgery staged according to its priority, especially if those injuries are life-threatening.
Recovery typically will include Physical Therapy to increase strength and range of motion after the bone has sufficiently healed. Although most people do well healing after an oblique fracture, there can be complications that can affect patients for the rest of their lives, such as a limp or difficulty with range of motion. That is why Physical Therapy is so important after an injury of this type, so that patients can achieve the most function that they can.